|
Brief Psychiatric Rating Scale (BPRS)
Please note that this section is an archive (last updated in June 2006). [disclaimer]
Sections:
Overview |
Instrument Reviews |
Construct Overviews |
Book Compendium Reviews |
Internet Site Reviews
|
|
|
|
Practical Information
|
Instrument Name:
|
Brief Psychiatric Rating Scale (BPRS)
|
Instrument Description:
|
The Brief Psychiatric Rating Scale (BPRS) was designed to assess treatment change in psychiatric patients as quickly and efficiently as possible. BPRS has sixteen symptom constructs: somatic concern, anxiety, emotional withdrawal, conceptual disorganization, guilt feelings, tension, mannerisms and posturing, grandiosity, depressive mood, hostility, suspiciousness, hallucinatory behavior, motor retardation, uncooperativeness, unusual thought content, and blunted affect. (Ref: 1)
The clinician rates the patient by observing tension, emotional withdrawal, mannerisms and posturing, motor retardation, and uncooperativeness. The other 11 constructs are rated based primarily upon verbal report. (Ref: 1) Measurement of other constructs has also been reported (thinking disturbance, hostility/suspiciousness, withdrawal/retardation, anxiety/depression). (Ref: 5)
|
Price:
|
$15.00 for manual and instrument; see “Research Contacts” for availability.
|
Administration Time:
|
Clinical Interview—18 mins; BPRS ratings—2 to 3 mins if clinician is familiar with BPRS.
|
Publication Year:
|
1962
|
Item Readability:
|
The Flesch-Kincaid grade level gave the BPRS an 11.1, which means that raters with an 11th grade reading level should comprehend the scale. Items appear appropriate for clinician raters, with terminology based on diagnostic concepts.
|
Scale Format:
|
Items on the BPRS use a 7-point ordinal scale, which includes "Not present," corresponding to a score of 1, to "Extremely severe," corresponding to 7.
|
Administration Technique:
|
Ratings on the BPRS scale are based upon observation of the patient and verbal report by the patient. (Ref: 4) To increase inter-rater reliability ratings, the developers suggested two clinicians interview the patients and make separate ratings at the end of the interview. An alternative suggested by the developers was to have raters discuss the interview and arrive at a joint rating of each symptom construct. (Ref: 1)
|
Scoring and Interpretation:
|
The individual item scores range from 1 (not present) to 7 (severe) and the sum of the scores on the 16 scales is the ‘total pathology” score. (Ref: 4) The higher the score, the greater the severity of psychiatric symptoms. (Ref: 6) Scores may also be weighted; weights were derived from 20 psychiatrists asked to rate “typical” hypothetical patients for several diagnoses in order to create BPRS target symptom profiles. Weights were provided for “paranoia, paranoid-state, and related reactions,” “paranoid schizophrenia,” “general schizophrenia,” “schizo-affective reaction, depressed,” “depression,” and “manic-depressive, manic.” (Ref: 1)
|
Forms:
|
In Ref 3 and Ref 6, a longer version of the BPRS was administered. The 19-item interviewer-rated BPRS scale assessed the severity of psychiatric symptoms in people with severe mental illness (SMI). The items were rated on a scale of 0 (not present) to 6 (severe) and the sum of the item scores ranged from 0 to 114. (Ref: 3,6) In Ref 4, an 18-item BPRS was administered to males with schizophrenia (Ref: 4)
|
|
|
Research Contacts
|
Instrument Developers:
|
John E. Overall and Donald R. Gorham
|
Instrument Development Location:
|
Kansas State University and V.A. Center N.P. Research Lab
|
Instrument Developer Email:
|
No information found
|
Instrument Developer Website:
|
www.psychrehab.com
|
|
|
Annotated Bibliography
|
1. Overall JE, Gorham DR. The Brief Psychiatric Rating Scale. Psychological Reports 1962; 10:799-812. [No PMID]
|
Purpose:
The Brief Psychiatric Rating Scale (BPRS) was designed to assess treatment change in psychiatric patients; a rapid and efficient approach was needed to evaluate patient symptomology.
|
|
|
Sample:
Twenty psychiatrists rated “typical” hypothetical patients in several categories, some of those included were: paranoia, manic depressive, and schizo reaction.
|
|
|
Methods:
The interview was a total of 18 minutes with time divided as follows: 3 minutes on building rapport, 10 minutes on non-directive interaction; and 5 minutes on direct questioning. After the interview, a clinician administers the BPRS.
|
|
|
Implications:
Descriptive and logistic information is provided for the BPRS. The authors purport that it is a quick and economical way to assess change due to treatment. The authors state that reliability of the BPRS depends upon the magnitude of true differences between individuals and upon the error in measuring these true differences.
|
2. Mathalon DH, Pfefferbaum A, Lim KO, Rosenbloom MJ, Sullivan EV. Compounded brain volume deficits in schizophrenia-alcoholism comorbidity. Arc Gen Psychiatry 2003 Mar; 60:245-52. [PMID: 12622657]
|
|
Purpose:
To examine the effect of schizophrenia and alcoholism on regional brain volumes.
|
|
|
Sample:
All participants were male and gave a written consent for participation in the study. There were four sample groups:
1) 35 men comorbid for DSM-III-R schizophrenia/schizoaffective disorder and lifetime alcohol abuse or dependence. The mean (SD) years of age was 38.5 (5.90) and the mean (SD) years of education was 12.7 (2.9);
2) 64 men with DSM-III-R schizophrenia or schizoaffective disorder who were not alcohol abusers or dependents. The mean (SD) years of age was 40.0 (8.60) and the mean (SD) years of education was 13.3 (2.0);
3) 62 men with Research Diagnostic Criteria alcoholism. The mean (SD) years of age was 44.6 (9.3) and the mean years of education was 13.45 (2.7); and
4) 62 healthy men (controls) screened using the Structured Clinical Interview for DSM-III-R or the Schedule for Affective Disorders and Schizophrenia. The mean (SD) years of age was 42.29 (11.2) and the mean (SD) years of education was 16.63 (2.7).
|
|
|
Methods:
Patients were from in-patient units of the Mental Health Clinical Research Center at the Veterans Affairs Palo Alto Health Care System. They also received medical screening and psychiatric assessment by a research psychiatrist or psychologist and a trained research assistant. The psychiatrist or psychologist conducted the clinical interview and the research assistant used the Structured Clinical Interview for DSM-III-R The BPRS was administered to the schizophrenic and comorbid subsamples to evaluate symptom severity. |
|
|
Implications:
An important factor associated with alcoholism-schizophrenia comorbidity is interruption of the frontoparietal and frontocerebellar circuitry; it can have negative effects on clinical, cognitive, motor functions. BPRS mean scores and standard deviations were reported for schizophrenic and comorbid patients.
|
3. Resnick SG, Neale MS, Rosenheck RA. Impact of public support payments, intensive psychiatric community care, and program fidelity on employment outcomes for people with severe mental illness. J Nerv Ment Dis 2003 Mar; 191(3): 139-44. [PMID:12637839]
|
|
Purpose:
To study the relationship between veterans with severe mental illness who receive disability support payments and who are enrolled in intensive psychiatric community care (IPCC), and how it relates to the likelihood of becoming employed.
|
|
|
Sample:
: The sample was randomized, veterans (N=271) in Intensive Psychiatric Community Care (IPCC) or standard care (N=257). Before entering the study, 455 (87.5%) participants were receiving at least one form of public support. The average amount of public support received per month was $955 (SD=$626). There were 46 workers and 474 non-workers at 12 months. Out of the 474 non-workers: 454 (95.8%) were male and 20 (4.2%) were female; 358 (75.7%) were White, 79 (16.7%) were Black, and 36 (7.6%) were Other; the years of age mean (SD) were 44.1 (13.0); the highest grade completed in school mean (SD) was 11.9 (2.5). Out of the 46 workers: 45 (97.8%) were male; 34 (73.9%) were White, 8 (17.4%) were Black, and 4 (8.7%) were Other; the years of age mean (SD) were 41.6 (12.0%); the highest grade completed in school mean (SD) was 12.6 (2.9%).
|
|
|
Methods:
Veterans were recruited from 1987 to 1990. Eligible veterans must have been hospitalized in a VA psychiatric inpatient unit at the time of recruitment, been in the hospital at least 40 or more days or had been in the hospital 2 times during the year prior to enrollment, and had a primary psychiatric diagnosis. The IPCC had seven teams--one site had two teams. There are four conditions that the IPCC was designed to operate under: (1) low staff to veteran ratio and frequent contact, (2) provision of services in the community, (3) focus on psychosocial rehabilitation, and (4) continuity of care. The standard VA care offered inpatient psychiatric and psychopharmocologic treatment, outpatient psychiatric treatment, and rehab services such as work therapy. The BPRS was administered at study entry and at one-year follow-up to assess symptom severity.
|
|
|
Implications:
The disability payment system (i.e. SSI and SSDI) might serve as an impediment because it can dissuade veterans from working. The impact of IPCC on employment had at least three potential mechanisms: a) veterans in IPCC had a locus of treatment, b) case managers in the IPCC program encouraged employment, and c) IPCC case managers were more likely to recommend veterans go to vocational services opposed to clinicians providing standard care. BPRS mean scores and standard deviations were reported. BPRS symptom scores did not significantly predict employment outcomes.
|
4. Sajatovic M, Bingham CR, Garver D, Ramirez LF, Ripper G, Blow F, Lehmann LS. An assessment of clinical practice of clozapine therapy for veterans. Psychiatric Svcs 2000 May; 51(5): 669-71. [PMID:10783190]
|
|
Purpose:
Clozapine therapy is an important form of therapy for veterans with severe treatment-refractory schizophrenia. The BPRS scale ratings were used to assess patients’ psychopathology within four weeks of beginning clozapine therapy.
|
|
|
Sample:
In the Veterans Affairs health care system clozapine therapy was used for 2,996 patients with treatment-refractory schizophrenia over a five-year period. Out of the 2,996 patients the BPRS scale was administered to 522 patients. The mean (SD) age of the group was 44.8 (10.2) years, with a range from 21 to 95 years. Out of the 2,448 veterans 132 were women (5.3 percent) and 2, 356 were men (94.7 percent). The patients were from the VA National Clozapine Coordinating Center.
|
|
|
Methods:
From October 1, 1991 to November 11, 1996 the BPRS was readministered quarterly for as long as the patient received clozapine therapy. An analysis of variance design (ANOVA) and chi square test were used to examine the change (s) in the overall BPRS score from to baseline to end.
|
|
|
Implications:
The patients with a stronger response to clozapine had higher BPRS scores in the beginning and were three times more likely to have been suicidal in the month prior to starting clozapine therapy. According to BPRS score changes, clozapine appeared to be an important treatment for veterans with treatment-refractory schizophrenia.
|
5. Ford JM, Mathalon DH, Marsh L, Faustman WO, Harris d, Hoff AL, Beal M, Pfefferbaum A. P300 amplitude is related to clinical state in severely and moderately ill patients with schizophrenia. Biol Psychiatry 1999; 46:94-101. [PMID:10394478]
|
|
Purpose:
To determine if there is a difference between N1 and P300 (auditory event-related brain potential, ERP) amongst severely ill and moderately ill schizophrenic patients, and whether N1 and P300 are related to symptom severity across all patients.
|
|
|
Sample:
All subjects were male. There were three sample groups:
1) Severely ill (N=28): mean (SD) years of age and years of education were 34.1 (7.7) and 10.2 (3.1), respectively;
2) Moderately ill (N=29): mean (SD) years of age and years of education were 36.7 (4.6) and 12.9 (1.5), respectively; and
3) Control subjects (N=30): mean (SD) years of age and years of education were 36.9 (6.7) and 16.0 (2.4), respectively.
|
|
|
Methods:
Severely ill patients were recruited from a locked in-patient ward at Napa State Hospital, moderately ill patients were in-patients and outpatients from a psychiatric ward at the VA Palo Alto Health Care System, and control subjects were recruited from the surrounding community. Controls responding to ads were screened over the phone and then later, if invited, were screened in the lab by the Schedule for Affective Disorders and Schizophrenia-Lifetime (SADS-L); they were excluded if there had been substance abuse in the past year or lifetime history of some kind of psychiatric disorder Clinical symptoms were assessed with the BPRS.
|
|
|
Implications:
Severely ill patients had smaller P300s than moderately ill patients and scored higher on three of the four BPRS subscales (computed in this study) as well as the BPRS total. The three BPRS subscales were: Thinking Disturbance, Withdrawal/Retardation, and Hostility/Suspiciousness). In addition, the severely ill had been ill longer and had less years of formal education.
|
6. Blow FC, Barry KL, Boots-Miller BJ, Copeland LA, McCormick R, Visnic S. Longitudinal assessment of inpatient use and functioning of seriously mentally ill veterans with and without co-occurring substance use disorders. J Psychiatric Res 1998; 32:311-19.[PMID:9789210]
|
|
Purpose:
To compare inpatient service use and functional outcomes (quality of life, symptomology, and cognitive functioning) among veterans with SMI to those veterans with a comorbid diagnosis of SMI and substance disorders.
|
|
|
Sample:
The 682 veterans had serious mental illness (SMI). Out of the 682, 3.2% (N=22) were female. Among the veterans, 85.9% (N=586) were Caucasian, 8.9% were African American, 4% were Hispanic, and 0.6% were American Indian; the range in age was 21 to 82 years; average of 12.2 years of school; 54% (N=369) had never been married, 32% (N=218) were divorced/separated; 90.3% (N=616) had schizophrenia and 7.7% Bipolar/Affective Psychoses. Patients were placed in a psychosocial program for treatment: STAR II (53%), day treatment (20%), assertive community case management (21%), and other enhanced programming (6%).
|
|
|
Methods:
: Recruitment took place at twelve VA hospitals that were able to fund the treatment teams so they could intervene and perform specialized psychosocial treatment for SMI veterans. There were follow-ups at six months, 12 months, 18 months, two years, three years, and four years; the schedule was subject to change. The way participants were recruited from each VA varied. The surveys were administered by on-site program directors and evaluation coordinators. The treatment teams included physicians, psychiatrists, social workers, and nurses. The veterans had to be eligible for hospital care, have a DSM-III-R diagnosis of psychosis and 150 days of hospitalization in the year prior to admission to the specialized programming or at least five admissions during that year. Treatment placement was based on predominant intervention offered to the patients. The BPRS was administered to assess symptom severity.
|
|
|
Implications:
SMI patients had significantly fewer psychiatric symptoms measured by the BPRS than comorbid patients, and all patients showed improvement on the BPRS. There were demographic differences between the two groups, because non-Caucasians were less likely to be in the follow-up group than were Caucasians, and women were less likely to be in the follow-up group than men. Utilization of psychosocial treatment service--specialized programming-- was found to benefit SMI patients with co-occurring substance use disorders. However, there was no actual data on substance abuse behaviors of the patients.
|
7. Sajatovic M, Ramirez, Garver D, Thompson P, Ripper G, Lehmann LS. Clozapine therapy for older veterans. Psychiatr Serv 1998 Mar; 49:340-44. [PMID:9525793]
|
|
Purpose:
To assess the outcomes of clozapine therapy in the older adult veterans population and examine the differences in response to clozapine.
|
|
|
Sample:
The veterans (N=329) were age 55 and older. Later, they were grouped by ages: patients between ages 55-64 and patients between ages 65-86. The mean (SD) age of the younger group was 59.3 (2.8) years and in the older group the mean (SD) age was 70.8 (4.3) years. The sample had 294 men (94.2%) and 18 women (5.8%); 270 Caucasians (86.5%), 33 African Americans (10.6%), and five Hispanics (1.6%); 267 patients (85.6%) had a diagnosis of schizophrenia, and the most common comorbid illness for 26 out of 208 patients was hypertension (12.5%). The mean (SD) duration of clozapine therapy was 278 (266) days, with a range of 2 to 1,379 days. The mean (SD) clozapine dosage was 310 (233) mg a day, with a range of 12.5 to 900 mg a day.
|
|
|
Methods:
Veterans were recruited over a five-year period from October 1, 1991 to March 1, 1996, by the VA National Clozapine Coordinating Center. Eligibility requirements included a history of treatment-refractory psychosis or intolerance to conventional neuroleptics. Psychopathology was rated at baseline and quarterly thereafter with the BPRS. The variations of responses to clozapine between the two age groups were compared using t tests and chi square analysis.
|
|
|
Implications:
Overall, the sample of the veterans improved on clozapine therapy, with a trend that showed veterans between 55 and 64 years had greater improvement. The overall improvement in scores on BPRS items indicating aggression suggests that increased assaultiveness behavior in the veteran sample was decreased by clozapine therapy. No significant difference was found between the two age groups in the number of patients remaining on clozapine therapy and the number for whom therapy was discontinued. Lastly, the absence of suicides over a five-year period might suggest that clozapine may reduce suicidality.
|
|
|
top
|
Factors and Norms
|
Factor Analysis Work:
|
Factor analysis of the Lorr’s Multidimensional Scale for Rating Psychiatric patients (MSRPP; 1953) and the Inpatient Multidimensional Psychiatric Scale (IMPS; 1960) resulted in sixteen symptom constructs, which are included in the BPRS. (Ref: 1)
|
Normative Information Availability:
|
Although specific normative information was not found, four studies reported BPRS scores means and standard deviations (SD). The total BPRS score mean (SD) was 14.6 (8.1) for a sample of 474 non-workers. (Ref: 3) The BPRS scores mean (SD) at the end of the two-year study, for 682 SMI veterans was 17.0 (11.3). (Ref: 6) The BPRS total score mean (SD) for a sample of 522 veterans with treatment-refractory schizophrenia was 49.6 (14.1). (Ref: 4) Please consult these articles for further information. Perhaps list the range of possible scores to give the norms more of a context.
|
|
|
Reliability Evidence
|
Test-retest:
|
No information found.
|
Inter-rater:
|
Inter-rater reliability among a sample of 112 newly admitted schizophrenics (and reportedly homogeneous in nature), based on the initial 14 items, ranged from 0.74 to 0.90 with the exception of four items: emotional withdrawal (0.70), tension (0.52), mannerisms and posturing (0.67), and suspiciousness (0.70). After the addition of two more items, inter-rater reliability was again assessed among 83 newly admitted schizophrenics. Coefficients ranged from 0.72 to 0.87 with the exception of four items: emotional withdrawal (0.62), tension (0.56), uncooperativeness (0.68), and blunted affect (0.67). (Ref: 1)
|
Internal Consistency:
|
There was an alpha coefficient of 0.83 on the 19-item BPRS. (Ref: 6)
|
Alternate Forms:
|
No information found.
|
|
|
Validity Evidence
|
Construct/ Convergent/ Discriminant:
|
No information found.
|
Criterion-related/ Concurrent/ Predictive:
|
No information found.
|
Content:
|
No information found. The BPRS items were based on multivariate analysis of psychiatric data and consensus of an expert panel of 12 psychiatrists and psychologists. (Ref: 1)
|
Responsiveness Evidence:
|
Within four weeks of beginning clozapine therapy, the BPRS was used to rate psychopathology among veterans with treatment-refractory schizophrenia. The BPRS was re-administered every three months as long as the patient remained on clozapine. There was significant (p<0.001) change in mean BPRS scores (total and subscales) with clozapine therapy. (Ref: 4) Another study similarly used the BPRS to assess clozapine treatment among treatment-refractory veterans. Veterans aged 55-64 years had mean improvement of 19.8% in total BPRS scores, with 42.6% showing improvement of more than 20%. Veterans 65 years and older had mean improvement of 5.7%, with 17.2% showing improvement of more than 20% (p=0.02). (Ref: 7)
|
Scale Application in VA Populations:
|
Yes. (Ref: 1-2,4,6-7)
|
Scale Application in non-VA Populations:
|
Yes. (Ref: 3,5)
|
|
|
Comments
|
The BPRS is a clinician-administered tool designed to assess psychiatric symptoms in a rapid and efficient way. A skilled clinician should be able to administer the instrument in 30 minutes or less. The BPRS results in a total score, where higher scores indicate greater symptom severity.
Overall Usefulness for a Certain Population: The BPRS has been used among veterans, alcoholics, schizophrenics, healthy controls, and those with bipolar or affective disorders. The samples have consisted primarily of Caucasian males, although the scale has been used with females and African Americans, Hispanics, and American Indians.
Advantages: The BPRS appears to have a rich history of use among clinicians. In comparison to other interview and observational tools used in psychiatric assessment, it is brief and does not take long to administer. It appears responsive to treatment change. In general, inter-rater reliability is adequate and internal consistency (for one sample) was good.
Disadvantages: Information concerning validity evidence is very sparse. Consensus among BPRS items and current DSM criteria was not found.
Recommendation: The BPRS is an effective tool for research among those with severe mental illness/psychiatric disorders, because it can be administered quickly. However, use of more exhaustive and comprehensive methods would be a better approach to assessing symptoms in order to monitor individual patients. Further psychometric work should address the convergence of the BPRS with related constructs, as well as its association with current clinical diagnoses.
|
|
|
|
